Seán Kyne (Fine Gael)
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The Minister of State is welcome. I thank the Leas-Chathaoirleach for choosing this Commencement debate. As a member of the Joint Committee on Health, I am raising the need to update the Dentists Act 1985. There are a number of aspects of the Act that need to be updated and improved in order to prevent the fall-out that befell parents and children in County Galway last year when an orthodontist in Oranmore closed. Serious questions remain with regard to record sharing, protocol responsibility, moneys being paid and insurance, among others, and these areas require updating. Parents are still feeling the effects of that.

I raised this matter with the Irish Dental Association at a meeting of the Joint Committee on Health on 5 July. At that meeting, Mr. Fintan Hourihan, the CEO of the Irish Dental Association, stated:

It is critical to get in to prevent a problem so, if, for some reason, a dentist is having difficulty continuing in practice, there is an opportunity to intervene at an early stage and sit down to try to work out a solution, rather than wait for the inevitable. That requires a change in the legislation. The Dental Council will say, correctly, it is not entitled to proactively contact a dentist or visit a dental practice because the legislation does not allow for that and that, ultimately, dental practices are private enterprises. As an association, we believe there should be changes to the legislation to allow that, in the interests of the dentists, who may be in difficult circumstances, and of their patients, who will suffer as a consequence. We support the Dental Council in calling for legislation which will allow it to intervene proactively in such a scenario.

At the same meeting, Dr. Eamon Croke, the president of the Irish Dental Association, stated:

We have come across people who have come into the country and have closed the doors overnight and left. Change in legislation is required to get in there and deal with the human side of it.

I have spoken again to parents in the general Galway area as the orthodontist in question had clients all over the county. They have stated that many people have contacted the Competition and Consumer Protection Commission, CCPC, to get support. They say that where a dentist has insurance, the insurance company should refund the parents for the loss they incurred. They do not understand why that has not been the case. Regardless of what happens in the courts, the orthodontist's insurance should surely cover the costs. However, the insurance company is not engaging and Government intervention is needed to support the claims for insurance.

I wrote to the Minister for Health in August. He replied that the matter of refunding the money paid is not really up to his Department. He stated:

Issues relating to the refunding of fees are, unfortunately a broader issue, outside the remit of my Department, instead relating to consumer law under the Department of Enterprise, Trade and Employment (DETE) and so the Competition and Consumer Protection Commission (CCPC) is the statutory body responsible for promoting compliance with, and enforcing, competition and consumer protection law in Ireland and are best placed to advise ...

As I said, parents have contacted the CCPC and they have received no support. The Minister agreed on the wider need to update the legislation because this could happen again. We are left in a situation where no one can intervene. No one can go and collect the files or proactively engage. As I said, people can come into the country, set up a practice and then close the doors and leave. They may have collected money but they can leave children or patients halfway through procedures with a mouthful of braces and everything else like that. Those patients could be left in a situation where they have paid upfront and their care is left incomplete. There is an urgent need to update this legislation. I look forward to the Minister of State's response.

Anne Rabbitte (Galway East, Fianna Fail)
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I am taking this matter on behalf of the Minister for Health, Deputy Donnelly. I thank the Senator for the opportunity to address the issue of the review and updating of the Dentists Act 1985. The practice of dentistry is underpinned by a range of Acts, of which the Dentists Act 1985 is only one. The Department of Health plays an active role in developing and amending relevant legislation to align with best international practice. The Minister for Health is committed to reviewing and updating the Dentists Act 1985.The protection of the public and ensuring high oral healthcare standards will continue to be the central focus of this work. The review and updating of the legislation are directly related to the wider implementation of the national oral health policy which envisages a fundamental reform of oral health services in Ireland.

In September 2022, as the Senator referenced, following the cessation of practice of a specialist orthodontist in Galway, the Minister for Health met patient representatives and local representatives to listen to their specific concerns and to consider possible options. The usual course of events would be that orthodontic practices are wound down in an orderly fashion when necessary, with patients continuing to receive care in other practices, as arranged by the dentist providing their care. In the case referred to by the Senator, due to the circumstances of the cessation of practice of the specialist orthodontist, this was not possible. Officials in the Department of Health have worked with the Dental Council and relevant stakeholders to ensure that everything possible was done to resolve the concerns of patients affected. To support patients to receive continuity of care, the Dental Council wrote to orthodontists located nearest to the practice to seek their cooperation to provide care to former patients of this practice. The Orthodontic Society of Ireland also coordinated with its members to seek ways to resolve this situation to enable ongoing care to be restored as soon as possible.

Issues relating to the refund of fees are, unfortunately, a broader issue outside the remit of the Department of Health. Instead, they are related to consumer law which is under the remit of the Department of Enterprise, Trade and Employment. The Competition and Consumer Protection Commission is the statutory body responsible for promoting compliance with, and enforcement of, competition and consumer protection law in Ireland and is best placed to advise on any concerns regarding the refund of professional fees.

That is the response from the Minister for Health and the Department but it would not be correct of me to stand here and not acknowledge the upset and frustration that has been caused to these families. Senator Kyne, like me, is representing a lot of these families who are now at the end of their tether because they had to pay out not just once, but twice. Children were left with their mouths full of braces and did not know where to turn. It has gone on for far too long and the Senator is quite right to point out that while this is just one example, there is nothing to say it will not happen again. There is no reassurance within the legislation of either prevention or assistance. This should be a priority within oral health. The legislation should be amended as soon as possible. This has caused a lot of upset and frustration. Many of the children affected were doing exams at the time. I will encourage the Minister for Health, Deputy Donnelly, to get his officials to address this as soon as possible.

Seán Kyne (Fine Gael)
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I thank the Minister of State for conveying the response from the Minister for Health, Deputy Donnelly, and for her own words as a fellow Galway politician working on behalf of parents and children in this area.

There are two issues here. First, there is a need to update the legislation for the future as quickly as possible because this could happen again in Galway or in any other county in the country and parents and children could be left high and dry. Second, we have the issue of refunds vis-à-vis the costs parents have incurred not once, but twice as the Minister of State said. They paid up front, in many cases, for the work but were left high and dry unfortunately. Then they had to pay a second time. There is no assistance forthcoming and that is not good enough. It is not right that parents in our county of Galway had to pay twice for dental care for their children or themselves. The Department or a relevant Government agency must take a lead on this and ensure that these people are supported. If the insurer does not pay out then some other method must be found by the State to ensure they get a refund.

Anne Rabbitte (Galway East, Fianna Fail)
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I will read the Minister's closing statement and then add my own remarks. I have listened to colleagues across the Chamber and have taken on board the points they have made. I can assure them that ensuring the continued protection of the public and high oral healthcare standards is a priority for the Minister for Health. The Minister is committed to reviewing and updating the Dentists Act 1985. As part of implementation of the national oral health policy additional resources have been allocated within the Department of Health to work on further strengthening the regulation of dentists in Ireland. The Department is currently undertaking preparatory scoping and planning work to support the review of this legislation and is also considering the different areas of reform referenced by the Dental Council in its 2021 submission to the Department. The process of developing legislation involves consultation with the public and other stakeholders. Officials from the Department have met with officials from the Dental Council several times in recent weeks to discuss a range of issues, including the Dental Council’s proposals for legislative reform. Officials will continue to consult with the Dental Council as an important stakeholder as this work progresses. The Department welcomes positive engagement from all stakeholders, including the public and wider dental profession, in this regard. The Minister is confident that, informed by this engagement, we will be able to deliver a robust, evidence-based modern regulatory framework which supports the national oral health policy and the associated reforms targeted for oral healthcare. Any legislative change will obviously be a matter for consideration and decision by the Oireachtas in due course.

In my view, the Dental Council has a significant role to play here because it has its own insurance and I would assume that insurance would protect the council's membership. When one of its members failed to deliver services to the public for which he or she had been already paid, the Dental Council should have used its insurance to reimburse affected families.